Risk Factors Identified for Chronic Work Disability
Chronic back pain, a common disability, accounts for a majority of work disability costs. Although most people who have acute back pain don't progress on to chronic back pain, there aren't many ways to determine which patients are at higher risk of going on to chronic pain. If doctors could identify them ahead of time, secondary prevention, which means preventing further pain and injury, could be better targeted.
The authors of this article studied 1885 patents with lower back pain to see if they could determine certain predictors that would tell them if a patient was at high risk for needing work disability. Researchers interviewed the patients after they had submitted claims for lost work due to back injuries. The patients were interviewed about three weeks after the claim was made.
The information collected included social issues (if they smoked, worked full time, the type of job, education, etc), their ability to function at work and leisure activities, health care, psychological issues, and so on. Part of this information was obtained using the Roland-Morris disability questionnaire (RDQ) and the Short form 36 (SF-36). The researchers also looked at the medical records for further information.
What the researchers found was that the strongest predictor of someone taking off a year of work (one-year disability) was the severity of the injury (including if pain went down below the knee), followed by the type of specialist the patient saw, functional ability, how many places the pain was located, how stressed the job was, if accommodated work was available, and if the patient had had an earlier back injury for which they took off at least a month.
Using these findings, the authors pointed out that there are several things that can be done for patients with back pain to minimize the risk of them needed a prolonged period of time off work. For example, patients who saw chiropractors as their first specialist seemed to do better in recovering from pain. Patients whose employers were flexible and allowed them to do different work or brought them back on a modified schedule did better as well. Other issues, like relieving stress i the workplace could also be addressed.
Some issues can't be addressed as easily, but if patients have pain that radiates down or has pain in multiple areas, this could be taken as a warning that the patient is potentially one who may end up with chronic pain issues.
Interestingly, the researchers found that although if someone did take off a month or more for a previous back injury, an earlier back injury on its own didn't affect whether they would likely take a longer time off work this time around.
Judith A. Turner, PhD, et al. ISSLS Prize Winner: Early Predictors of Chronic Work Disability. In Spine. December 1, 2008. Vol. 33. No. 25. Pp. 2809-2818.